| NPI | 1396266573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2022023198) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AR 8509-M) |
| 104100000X Social Worker | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2022-07-11 |