| NPI | 1417670654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2022046260) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2020031628) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2022-12-02 |