| NPI | 1083807630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: UT 10511606-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2025-07-31 |