| NPI | 1316516594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-43787) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AK 167881) |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2026-01-07 |