| NPI | 1902913346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MD 03962) |
| Additional Taxonomies | 104100000X Social Worker (Licence: DC LC301088) |
| 106H00000X Marriage & Family Therapist (Licence: MD LCM085) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2007-07-08 |