| NPI | 1790561322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: SC 16492) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW127521) |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW008743) | |
| Enumeration Date | 2023-09-08 |
| Last Update Date | 2025-07-01 |