| NPI | 1225033400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904016797) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50078352) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2024-08-28 |