| NPI | 1790239572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2019014404) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2016026179) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2019-05-06 |