| NPI | 1841731684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 14109) |
| Additional Taxonomies | 104100000X Social Worker |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2025-12-15 |