| NPI | 1952875767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WV BP00945034) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WV BP00945034) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2019-01-15 |