| NPI | 1114191152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2023047952) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 1072) |
| 104100000X Social Worker (Licence: NE 2119) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2023-12-20 |