| NPI | 1144954132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904014314) |
| Additional Taxonomies | 104100000X Social Worker (Licence: GA MSW010530) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2022-12-22 |