| NPI | 1629961693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 12350-M) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN 14515) |
| Enumeration Date | 2025-05-29 |
| Last Update Date | 2025-05-29 |