| NPI | 1912482829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2020027643) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2018011512) |
| 1041C0700X Social Worker, Clinical (Licence: TX 108421) | |
| 1041C0700X Social Worker, Clinical (Licence: IN 34010043A) | |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2023-01-19 |