| NPI | 1538206487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2001026066) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 3745) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2022-03-30 |