| NPI | 1063198349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2025-07-29 |