| NPI | 1013468750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 124151) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 123110) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC200002320) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904014212) | |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2026-07-07 |