| NPI | 1669020624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904015760) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2024-04-15 |