| NPI | 1487947347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 16028) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: VA 0904008667) |
| 1041C0700X Social Worker Clinical (Licence: DC LC50080023) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2024-04-05 |