| NPI | 1689459711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C019590) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P019166) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2026-03-12 |