| NPI | 1225234370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW11402) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 114059) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2017-01-26 |