| NPI | 1891349254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 010647) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 10647) |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2019-10-31 |