| NPI | 1194182212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 18827) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904009110) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2016-01-20 |