| NPI | 1538511795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 9089224-3501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 9089224-3502) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2025-04-15 |