| NPI | 1891244687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 9661-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904009626) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2022-04-13 |