| NPI | 1477302313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 09933487) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 121370) |
| Enumeration Date | 2024-05-14 |
| Last Update Date | 2026-07-14 |