| NPI | 1366920167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA LW70075563) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.018327) |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2026-01-20 |