| NPI | 1043357973 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW20002) | 
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 4635) | 
| Enumeration Date | 2007-01-31 | 
| Last Update Date | 2025-06-13 |