| NPI | 1790749505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV CP00450559) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA V00308) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2008-01-29 |