| NPI | 1528577954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50082153) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DC LG50081252) |
| Enumeration Date | 2017-09-28 |
| Last Update Date | 2019-09-18 |