| NPI | 1316528847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2022042255) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AR 11212-M) |
| 1041C0700X Social Worker, Clinical (Licence: AR pending) | |
| 1041C0700X Social Worker, Clinical (Licence: MO 2019027209) | |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2026-06-09 |