| NPI | 1316657968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2014005791) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW20419) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2026-04-07 |