| NPI | 1093357766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2023039684) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2019038963) |
| Enumeration Date | 2019-10-14 |
| Last Update Date | 2024-10-23 |