| NPI | 1821113895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-38601) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW-27751) |
| 246ZE0500X Specialist/Technologist, Other, EEG | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-06-15 |