| NPI | 1962778340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-5208) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 373906-3501) |
| 1041C0700X Social Worker, Clinical (Licence: MO 2022025822) | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2025-01-15 |