| NPI | 1669001665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2021038693) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2019021597) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2021-09-23 |