| NPI | 1073201935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 12468-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 131470-121) |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2025-07-28 |