| NPI | 1558439182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KS 4018) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS LMSW 5746) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2025-12-17 |