| NPI | 1295193381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW13085) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA SW0108782) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2017-03-09 |