| NPI | 1790734986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CT 006593) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 006593) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2026-02-09 |