| NPI | 1013797554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: DC LG200002709) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0903003910) |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2023-10-29 |