| NPI | 1467515551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904002208) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC00300287) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-08 |