| NPI | 1770062689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: DE Q1-0001634) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 100220) |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2025-04-30 |