| NPI | 1144377557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00942707) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L5140) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2026-01-06 |