| NPI | 1205379278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 8759-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 1984) |
| 1041C0700X Social Worker, Clinical (Licence: IA 123759) | |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2025-08-11 |