| NPI | 1013217173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50078937) |
| 1041C0700X Social Worker, Clinical (Licence: MD 16309) | |
| Enumeration Date | 2010-10-23 |
| Last Update Date | 2018-03-17 |