| NPI | 1962778340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MO 2022025822) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: UT 373906-3501) |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2023-01-06 |