| NPI | 1407925514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 06169) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904001984) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2008-10-10 |