| NPI | 1043652639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2014019232) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2011035380) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2023-10-04 |