| NPI | 1659325405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC302271) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904003604) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2017-01-12 |