| NPI | 1699098921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW9080) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 1026212) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2010-03-01 |