| NPI | 1386855609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC3014988) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904009415) |
| 1041C0700X Social Worker, Clinical (Licence: MD 11442) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2023-01-16 |