| NPI | 1134542830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW13540) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2019-03-15 |