| NPI | 1649713520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 17346) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50081014) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2016-11-28 |