| NPI | 1770039273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904011521) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 22509) |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2022-10-10 |