| NPI | 1972254043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC200002543) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DC LG50083631) |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2023-09-22 |