| NPI | 1174327639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 30640) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LG200002435) |
| Enumeration Date | 2025-04-03 |
| Last Update Date | 2025-04-03 |