| NPI | 1639392624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC303086) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 08422) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2007-07-08 |