| NPI | 1902156466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2025-0903) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW023645) |
| 104100000X Social Worker (Licence: PA SW128940) | |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2026-05-19 |