| NPI | 1003066986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW10773) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2012-05-03 |