| NPI | 1285652370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW7101) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC9524) |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW002292) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2015-01-06 |