| NPI | 1881369338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 27660) |
| Additional Taxonomies | 225XM0800X Occupational Therapist Mental Health |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2024-04-30 |