| NPI | 1689682346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW6688) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW01446) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2011-05-19 |