| NPI | 1972837276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NV 11663-C) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC C015122) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2024-07-23 |