| NPI | 1033887054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904015430) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 99105879A) |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2024-02-14 |