| NPI | 1790939692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2005025982) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 16513) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2024-08-03 |