| NPI | 1871103234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904014390) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2024-06-13 |