| NPI | 1366048662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 28308) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904012542) |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2025-07-16 |