| NPI | 1396097077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2015044692) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2012013648) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2020-11-19 |