| NPI | 1790483733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW25767) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 26139) |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2025-12-16 |