| NPI | 1710045331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904005084) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC 00300529) |
| 1041C0700X Social Worker, Clinical (Licence: MD 04242) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |