| NPI | 1043915242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 31574) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2024-06-10 |