| NPI | 1548673387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50080958) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DC LG50081076) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2017-02-27 |