| NPI | 1033267802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 07933) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904004377) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC302377) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |