| NPI | 1063679892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C017855) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904006732) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2025-12-10 |