| NPI | 1962908301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: VA 349181) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: VA PPS349181) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2018-04-04 |