| NPI | 1003231499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50079628) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 17261) |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2014-02-21 |