| NPI | 1659547396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 16934) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50078975) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2019-07-30 |