| NPI | 1396177846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: DC HHA8514) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2013-08-07 |