| NPI | 1568708048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL S000521772940) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL S000521772940) |
| Enumeration Date | 2013-01-02 |
| Last Update Date | 2013-01-02 |