| NPI | 1194134163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: AL 6462C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-37070) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2026-10-02 |