| NPI | 1093023012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 123302) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 7077414-3501) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2026-04-22 |