| NPI | 1891271649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C015114) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NC C015114) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2025-09-04 |