| NPI | 1336579762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50082004) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 18615) |
| 1041C0700X Social Worker, Clinical (Licence: MD 18615) | |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2025-06-12 |