| NPI | 1841313434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 5912027-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904007524) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2018-07-19 |