| NPI | 1275955916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008445) |
| Additional Taxonomies | 251S00000X (Licence: VA 0904008445) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2024-02-12 |