| NPI | 1295944254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 10749) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC3000796) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904005217) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2014-01-08 |