| NPI | 1104487024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 9857-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 130766) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2025-04-22 |