| NPI | 1083822720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904007232) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2024-03-13 |