| NPI | 1518107622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW9627) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 14955) |
| Enumeration Date | 2009-03-02 |
| Last Update Date | 2019-10-24 |