| NPI | 1821669912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: UT 284431-3502) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 284431-3506) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2023-05-26 |