| NPI | 1174062046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C012054) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 13202) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2026-06-15 |