| NPI | 1396027785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 15043) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50079230) |
| Enumeration Date | 2011-09-13 |
| Last Update Date | 2012-11-13 |