| NPI | 1871873554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008047) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW18404) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2021-09-17 |