| NPI | 1073655536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW6604) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 10349) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-10-29 |