| NPI | 1194470492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 9669) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN 13558) |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2025-07-01 |