| NPI | 1760927586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2016034259) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 10198) |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2022-06-15 |