| NPI | 1558095349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904014064) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC200004416) |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2025-10-17 |