| NPI | 1659628501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 17852) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC lc50079499) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2012-08-10 |