| NPI | 1215418983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-05771) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 119237) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2026-03-31 |