| NPI | 1003315938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 121045) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50081520) |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2019-11-01 |