| NPI | 1407462286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50080136) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904010738) |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2020-09-17 |