| NPI | 1295038206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL ISW8047) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL PSW814) |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2013-05-16 |