| NPI | 1831872191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 107123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 107123) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149025767) | |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2024-02-21 |