| NPI | 1841508025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5175579-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 51755793506) |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2024-10-24 |