| NPI | 1568917698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904009578) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0903002065) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2016-08-18 |