| NPI | 1356732945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW13755) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 17053) |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2018-11-06 |