| NPI | 1073306742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV CP00945832) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WV BP00945832) |
| Enumeration Date | 2025-05-27 |
| Last Update Date | 2025-06-23 |