| NPI | 1285402982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904017992) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0906012955) |
| Enumeration Date | 2023-12-13 |
| Last Update Date | 2025-02-18 |