| NPI | 1518486075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2018012929) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2015020805) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2020-08-25 |