| NPI | 1346015534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: LA 17439) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 17439) |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2025-08-19 |