| NPI | 1639595812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 19217) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50082094) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2022-08-29 |