| NPI | 1073136867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC200001952) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DC LG50083221) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2025-07-16 |