| NPI | 1457715369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904016771) |
| 1041C0700X Social Worker, Clinical (Licence: NC C011651) | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2025-04-15 |