| NPI | 1114609500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0901001817) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 21364) |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2023-08-03 |