| NPI | 1194938571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: VA 0904006561) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904006561) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2023-09-29 |