| NPI | 1528034857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904001148) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 1041C0700X Social Worker Clinical (Licence: VA 0904-001148) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2010-03-03 |