| NPI | 1942527965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 28958) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904013928) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC50078544) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2026-10-16 |