| NPI | 1306079082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 08702) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW7698) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2009-08-28 |