| NPI | 1932791373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2024004153) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1140755) |
| 1041C0700X Social Worker, Clinical (Licence: AK 241921) | |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2025-09-04 |