| NPI | 1235395419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50079737) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 13462) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2020-08-21 |