| NPI | 1598330276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 9615) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929599) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2025-09-26 |