| NPI | 1275081499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MO 2016029995) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2018031632) |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2020-06-25 |