| NPI | 1568999670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50082029) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD 21623) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2026-02-23 |