| NPI | 1780147215 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 15382) | 
| Additional Taxonomies | 1041C0700X Social Worker, Clinical | 
| 1041C0700X Social Worker, Clinical (Licence: FL SW15382) | |
| Enumeration Date | 2019-04-11 | 
| Last Update Date | 2025-07-29 |