| NPI | 1609554377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SD 6961) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SD 6396) |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2026-01-06 |