| NPI | 1063359800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 14694) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 8304) |
| Enumeration Date | 2026-04-30 |
| Last Update Date | 2026-04-30 |