| NPI | 1457088940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2024034052) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2022029271) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2024-08-28 |