| NPI | 1215239918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW 12404) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149006179) |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2016-04-24 |