| NPI | 1992512784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 224695) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 224900000X Mastectomy Fitter (Licence: MA 224695) | |
| Enumeration Date | 2024-12-16 |
| Last Update Date | 2024-12-16 |