| NPI | 1477892602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50080268) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904009930) |
| 1041C0700X Social Worker, Clinical (Licence: MD 18283) | |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2017-05-17 |