| NPI | 1417630450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL ISW20765) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW136529) |
| 1041C0700X Social Worker, Clinical (Licence: NH 1019) | |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2025-01-14 |