| NPI | 1952435455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 10009) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 09049012818) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC50082927) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 100097) | |
| 1041C0700X Social Worker, Clinical (Licence: WV DP00945920) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2025-06-19 |