| NPI | 1972512572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904006827) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL LCSW 2179) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-04-17 |