| NPI | 1922456235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-10748) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM M-09565) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2019-06-03 |