| NPI | 1194128256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 9307650-3501) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MO 2025016723) |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2025-06-10 |