| NPI | 1285089615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 14279) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: NC C017202) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2026-01-28 |