| NPI | 1952772881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI 5011) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101Y00000X Counselor | |
| Enumeration Date | 2015-10-19 |
| Last Update Date | 2024-06-25 |