| NPI | 1386981652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL LCSW11161) |
| Additional Taxonomies | 170300000X Genetic Counselor, MS (Licence: FL LCSW 11161) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2013-01-07 |