| NPI | 1508457821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LG50083530) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 26071) |
| Enumeration Date | 2021-01-29 |
| Last Update Date | 2021-02-05 |