| NPI | 1801175229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2024049967) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: UT 6885651-3503) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2026-03-27 |