| NPI | 1902917875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904010099) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50078732) |
| 1041C0700X Social Worker, Clinical (Licence: IA 06320) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2018-03-17 |