| NPI | 1306038963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 280654-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW002653) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2026-04-20 |