| NPI | 1922760222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 11391-C) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 124072073502) |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2024-04-22 |