| NPI | 1306667977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 28950) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC200004210) |
| Enumeration Date | 2024-10-17 |
| Last Update Date | 2025-08-14 |