| NPI | 1891262572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50082323) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904012829) |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2021-05-07 |