| NPI | 1336423995 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 4371852) | 
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 6409-C) | 
| Enumeration Date | 2011-09-30 | 
| Last Update Date | 2025-06-13 |