| NPI | 1861869927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 16948) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50080459) |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2015-08-25 |