| NPI | 1477751725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW11160) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 23846) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2013-09-27 |