| NPI | 1346512860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C008763) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NC C008763) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2025-06-25 |