| NPI | 1013601400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2025031871) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2023020107) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2025-07-29 |