| NPI | 1376806208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50080383) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 18136) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2021-09-28 |