| NPI | 1972629160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2008014112) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MO 2008014112) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2023-06-02 |