| NPI | 1154917649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2021026541) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2018027752) |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2021-07-08 |