| NPI | 1922673524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR LCSW11377) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR A5566) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2024-11-21 |