| NPI | 1134340672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0000970) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 11349) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2009-08-04 |