| NPI | 1447389846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL 13063) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 111335) |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2018-03-19 |