| NPI | 1609132075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2019028351) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2012010674) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2024-06-19 |