| NPI | 1740511849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00940427) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 15617) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904007035) | |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2012-07-17 |