| NPI | 1346890696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2021014789) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2019005818) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2021-05-03 |