| NPI | 1104370170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904009452) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50080779) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2016-08-08 |