| NPI | 1710718614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC PO21122) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P021122) |
| Enumeration Date | 2024-08-12 |
| Last Update Date | 2025-03-26 |