| NPI | 1740822337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2022024816) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2019036322) |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2022-08-01 |