| NPI | 1992393540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 18109) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 16004) |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2025-08-24 |