| NPI | 1841270212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 004880) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C002180) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2024-03-19 |