| NPI | 1013662139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: PA 021372) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 127339) |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2025-09-06 |