| NPI | 1710110655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 11906) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904002763) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC50078875) | |
| Enumeration Date | 2009-08-26 |
| Last Update Date | 2011-01-24 |