| NPI | 1124550728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 09243) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC302719) |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2017-04-01 |