| NPI | 1366535775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 2151-121) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 7248-123) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2025-09-11 |