| NPI | 1942419403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC 300787) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 04223) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2009-04-15 |