| NPI | 1144904632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2025042335) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2023033288) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2025-09-26 |