| NPI | 1124854187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904016452) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0904016452) |
| Enumeration Date | 2024-09-09 |
| Last Update Date | 2024-09-26 |