| NPI | 1952972788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 13455) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 15009) |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2024-11-26 |