| NPI | 1396491908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 16390) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| Enumeration Date | 2022-02-23 |
| Last Update Date | 2025-03-25 |