| NPI | 1841442340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C006665) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: FL 9663) | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2024-04-18 |