| NPI | 1861908634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 19648) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: DE Q1-0001592) |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2023-10-26 |