| NPI | 1902853948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 29045) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LMSW-26163) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2024-04-15 |