| NPI | 1790462893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CO CSW.09932683) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL TPSW6901) |
| Enumeration Date | 2023-06-29 |
| Last Update Date | 2026-07-02 |