| NPI | 1215352646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW13137) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149017147) |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2015-09-20 |