| NPI | 1376919944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 19365) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904015436) |
| 1041C0700X Social Worker, Clinical (Licence: DC LG50080686) | |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2023-10-18 |