| NPI | 1467863514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904015238) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 104100000X Social Worker | |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2023-05-09 |