| NPI | 1740870047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2025-05-21 |