| NPI | 1932982626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0906012967) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0903003625) |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2023-08-17 |