| NPI | 1457952632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 26139) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC200002745) |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2023-12-13 |