| NPI | 1730726415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-12-02 |
| Last Update Date | 2026-04-14 |