| NPI | 1912594847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: MD 25970) | |
| Enumeration Date | 2020-12-27 |
| Last Update Date | 2021-01-23 |