| NPI | 1962964395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 9450-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY 1362) |
| 1041C0700X Social Worker, Clinical (Licence: UT 12145054-3501) | |
| 104100000X Social Worker (Licence: TN 11474) | |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2021-08-11 |