| NPI | 1730866419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: ID 8911279) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 13409600-3501) |
| 1041C0700X Social Worker, Clinical (Licence: ID 8911279) | |
| 104100000X Social Worker (Licence: UT 13409600-3501) | |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2025-08-21 |