| NPI | 1003480898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904016645) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC200002913) |
| 1041C0700X Social Worker, Clinical (Licence: MD 32958) | |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2025-04-16 |