| NPI | 1134628761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2022014355) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.019970) |
| Enumeration Date | 2018-02-09 |
| Last Update Date | 2023-11-07 |