| NPI | 1700961109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW13986) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149011942) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW-687) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-09 |