| NPI | 1023533296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0000882) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 14888) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2017-08-09 |