| NPI | 1285239012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C017892) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC200002439) |
| 1041C0700X Social Worker, Clinical (Licence: MO 2022008122) | |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2026-03-31 |