| NPI | 1316083405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC301980) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 07771) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-07-09 |