| NPI | 1336583814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: DC LC50079248) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 09797) |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2013-04-26 |