| NPI | 1114239977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50079728) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 32875) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2025-06-29 |