| NPI | 1366925729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904017658) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2024-12-04 |