| NPI | 1457084139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 28461) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904018745) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2025-12-08 |