| NPI | 1831639103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 12128) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MS C8533) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2023-02-01 |