| NPI | 1275347155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 11459-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L15884) |
| Enumeration Date | 2025-02-03 |
| Last Update Date | 2025-02-03 |