| NPI | 1932290038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR LCSW-L15865) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904005368) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2024-12-03 |