| NPI | 1093764987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW0002652) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C004611) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2015-12-14 |