| NPI | 1407252216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2021000571) |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 7356881-3503) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2021-01-07 |