| NPI | 1790215390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NV 12617-C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904014820) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2026-03-26 |