| NPI | 1972644581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-4842) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 18626) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2023-08-02 |