| NPI | 1407982051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL MT 1029) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2019-11-26 |