| NPI | 1831871169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904001377) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 05188) |
| Enumeration Date | 2023-08-04 |
| Last Update Date | 2023-08-04 |