| NPI | 1699162487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904008329) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 15395) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC50079203) | |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2016-09-05 |