| NPI | 1386266708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 8911064) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW-42391) |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2026-05-22 |