| NPI | 1497476253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 8861139) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID LMSW-38728) |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2025-03-04 |