| NPI | 1972721124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 13050) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0001104) |
| 1041C0700X Social Worker, Clinical (Licence: NY 061583) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2023-01-12 |