| NPI | 1316049364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 10963) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904004884) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2020-01-09 |