| NPI | 1285442319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 32101) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904017583) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC200003757) | |
| Enumeration Date | 2024-12-20 |
| Last Update Date | 2025-02-17 |