| NPI | 1275688103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 3903) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 550) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |