| NPI | 1053945345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904011454) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 4325C) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2020-02-26 |