| NPI | 1760160394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 18383) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 16042) |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2025-11-04 |