| NPI | 1699107979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50079809) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2013012152) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904008304) | |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2021-06-02 |