| NPI | 1518453786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: C013216) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P012495) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2025-06-02 |