| NPI | 1952403115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 09040012424) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 11899) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2021-03-10 |