| NPI | 1073243697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MO 2021025112) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KS 12559-T) |
| Enumeration Date | 2022-06-15 |
| Last Update Date | 2024-07-22 |