| NPI | 1205121712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW9335) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL SW9335) |
| 1041S0200X Social Worker, School (Licence: FL SW9335) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2011-06-13 |