| NPI | 1699165118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: KS 9461) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2018034357) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2025-11-17 |