| NPI | 1487959060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2023019482) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 104100000X Social Worker (Licence: MO 2020021702) | |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2023-06-07 |