| NPI | 1770940264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC50079962) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904004877) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2016-01-28 |