| NPI | 1306015656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA 005368) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 10957) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW 8551) | |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2020-02-10 |