| NPI | 1598002404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50079789) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801090496) |
| Enumeration Date | 2013-01-11 |
| Last Update Date | 2013-07-24 |