| NPI | 1124293600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 12865) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: DC LC50078031) |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2008-04-25 |