| NPI | 1629549332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50079065) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904009265) |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2018-12-07 |