| NPI | 1861707036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 8666499-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 7435-C) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2022-07-29 |