| NPI | 1851874564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2018001714) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 4726) |
| Enumeration Date | 2018-09-09 |
| Last Update Date | 2020-10-29 |