| NPI | 1851867378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 7680) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR 13091) |
| 1041C0700X Social Worker, Clinical (Licence: ND 6238) | |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2022-08-05 |