| NPI | 1124758602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 28530) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 28530) |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2025-02-11 |