| NPI | 1346498664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW12979) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 116380) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2016-12-01 |