| NPI | 1104504646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2025009754) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2020036116) |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2025-04-08 |