| NPI | 1215158647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW 8615) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 002391) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2008-07-11 |