| NPI | 1932452448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WI 8581-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 35926) |
| 106H00000X Marriage & Family Therapist (Licence: WI 1127-124) | |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2026-03-10 |