| NPI | 1023546439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801114316) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 1041C0700X Social Worker, Clinical (Licence: IN 34008928A) | |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2025-06-12 |