| NPI | 1821771585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA SC61441830) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IL 150113957) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2025-07-25 |