| NPI | 1689229254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 24676) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: DC LG50082530) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2024-04-22 |