| NPI | 1225657992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MD 22764) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD LC200002753) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2026-07-02 |