| NPI | 1225644883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: DC LC200002714) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MD 25865) |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2025-07-26 |