| NPI | 1861518904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 20715) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50078601) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2021-09-16 |