| NPI | 1821639022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P014131) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2021-04-15 |