| NPI | 1508524505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 27223) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904016495) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC200003207) | |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2024-04-19 |