| NPI | 1407560576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 26382) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904017044) |
| Enumeration Date | 2023-01-12 |
| Last Update Date | 2025-08-21 |