| NPI | 1922825850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 31272) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW11835) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904016278) | |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2024-09-23 |