| NPI | 1831867944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2021040418) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 11097) |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2026-02-11 |