| 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 |