| NPI | 1518784586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR A15593) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 13027123) |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2026-06-23 |