| NPI | 1922699495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 7733) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 3805C) |
| Enumeration Date | 2021-01-28 |
| Last Update Date | 2021-01-28 |