| NPI | 1275607863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO SW004743) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS LSCSW 2126) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2024-11-27 |