| NPI | 1194507558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 12148-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 134443-121) |
| Enumeration Date | 2023-10-19 |
| Last Update Date | 2025-01-30 |