| NPI | 1194981936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW9176) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL ISW4354) |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2015-06-30 |