| NPI | 1265684492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 12184) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50077880) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2014-12-05 |