| NPI | 1780890582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 090400280) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC302452) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2015-09-04 |