| NPI | 1063488468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC303311) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 10721) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2007-07-08 |