| NPI | 1821263575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 08639) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: VA 0904003209) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2008-04-24 |