| NPI | 1912326091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC303351) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 10307) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2014-04-16 |