| NPI | 1366853095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW 10248) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C005272) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904006263) | |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2014-05-15 |