| NPI | 1194033233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MO 2012035819) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2012035819) |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2019-12-13 |