| NPI | 1396232831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 2021039475) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2019035068) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2021-09-30 |