| NPI | 1992300206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50082268) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904013560) |
| 1041C0700X Social Worker, Clinical (Licence: MD 23304) | |
| Enumeration Date | 2020-12-03 |
| Last Update Date | 2023-12-19 |