| NPI | 1740746908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 12031) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN 12031) |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2026-08-31 |