| NPI | 1134425994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 2013025358) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2013025358) |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2022-09-20 |