| NPI | 1811307903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 007987) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 007987) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2022-10-07 |