| NPI | 1871730879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: LA 18730) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-05300) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2024-10-06 |