| NPI | 1386259745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-43908) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV IC-1615) |
| Enumeration Date | 2020-09-12 |
| Last Update Date | 2026-02-21 |