| NPI | 1720171358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID 24803) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 5450383-3501) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2026-04-14 |