| NPI | 1215583034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 22151) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904012825) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05958500) | |
| 1041C0700X Social Worker, Clinical (Licence: DC LC50082176) | |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2025-05-30 |