| NPI | 1720394299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C006976) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: VA 0904012730) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2024-03-28 |