| NPI | 1659005627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C018673) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P017936) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2026-05-15 |