| NPI | 1215216684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00943879) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904013524) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2025-08-13 |