| NPI | 1386638955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW6126) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 15215) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2007-07-08 |