| NPI | 1043525975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50080644) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 080819) |
| 1041C0700X Social Worker, Clinical (Licence: MD 22607) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 904009730) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 80798) | |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2024-05-09 |