| NPI | 1174893945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904-001362) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW0002836) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2023-05-18 |