| NPI | 1740601806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LG1000364) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MD G11236) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2013-12-16 |