| NPI | 1942431176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 15294) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LC50078802) |
| 251S00000X Community/Behavioral Health (Licence: DC LC50078802) | |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2010-04-19 |