| NPI | 1255584934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 14544) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50078597) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2009-10-26 |