| NPI | 1063852200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 22556) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50082285) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2021-12-08 |