| NPI | 1770784415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904002802LCSW) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC0300900LICSW) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2007-07-08 |