| NPI | 1457625527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008842) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50079223) |
| 1041C0700X Social Worker, Clinical (Licence: MD 13813) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: MD 13813) | |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2024-03-22 |