| NPI | 1891222170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2019013326) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2016030932) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2023-08-01 |