| NPI | 1023332301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: HI 3819) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL TPSW6111) |
| 1041C0700X Social Worker, Clinical (Licence: NV 12398-C) | |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2025-10-27 |