| NPI | 1316496045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW17232) |
| Additional Taxonomies | 104100000X Social Worker (Licence: GA MSW007015) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2026-04-17 |