| NPI | 1346777182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2023005168) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2023-02-14 |