| NPI | 1689330946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC200001880) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904014081) |
| 1041C0700X Social Worker, Clinical (Licence: MD 25783) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 129977) | |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2025-11-17 |