| NPI | 1578641734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: FL SW4769) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW4769) |
| 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics (Licence: FL SW4769) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2011-09-07 |