| NPI | 1912560095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C015584) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 14805) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2023-02-24 |