| NPI | 1982740601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD G11954) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DC LG50028254) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-07-09 |