| NPI | 1558879312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2017038008) |
| Enumeration Date | 2018-01-16 |
| Last Update Date | 2020-10-21 |