| NPI | 1265290571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2024020481) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2021031639) |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-07-15 |