| NPI | 1700502564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC20002751) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904015251) |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2026-07-25 |