| NPI | 1952777476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 8342) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 5797085-3503) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2023-01-25 |