| NPI | 1588243836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 10073-123) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 131968-121) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2025-08-05 |