| NPI | 1457331605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5344281-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MT 945) |
| Enumeration Date | 2006-01-21 |
| Last Update Date | 2026-03-09 |