| NPI | 1780951178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0001381) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 19221) |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2015-08-28 |