| NPI | 1659515260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904015616) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 989787) |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2025-10-29 |