| NPI | 1245264340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN LSW5568) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW015161) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2026-01-08 |