| NPI | 1619616299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2022030684) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 0000) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2023-04-21 |