| NPI | 1639480841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 11179) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50078189) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2020-11-05 |