| NPI | 1184857823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW11699) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA SW127292) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2014-04-11 |