| NPI | 1366974610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 22821) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 17443) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904009872) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2025-04-05 |