| NPI | 1548327315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0904006478) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MD 15421) |
| 1041C0700X Social Worker Clinical (Licence: DC LC50078766) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2010-03-15 |