| NPI | 1972029494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 10591) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 3903) |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2019-05-12 |