| NPI | 1447827118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 29757) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 18186) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2026-03-19 |