| NPI | 1982918538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2007035726) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 105997) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2022-06-23 |