| NPI | 1265666580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC303138) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 09896) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2009-05-14 |