| NPI | 1750774840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 16953) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50079999) |
| Enumeration Date | 2015-03-12 |
| Last Update Date | 2015-03-12 |