| NPI | 1154795862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008888) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50080290) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-18 |