| NPI | 1255721403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 16607) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 09040008836) |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2015-01-27 |