| NPI | 1548725203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904011005) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2025-07-15 |