| NPI | 1407126998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 13847) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI 3581) |
| Enumeration Date | 2011-12-30 |
| Last Update Date | 2018-03-16 |