| NPI | 1730814005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L15438) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2024023364) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2024-08-12 |