| NPI | 1629493242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L15619) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 7543574-3503) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2025-05-07 |