| NPI | 1285114876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: KS 10930) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KS 05342) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2025-07-08 |