| NPI | 1952856726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-39042) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L13349) |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2025-12-15 |