| NPI | 1912650474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 27493) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 27493) |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2023-07-28 |