| NPI | 1598818072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0000326) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 10735) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2007-07-08 |