| NPI | 1083071914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 16819) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC3000888) |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2016-01-22 |