| NPI | 1730281155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL sw6140) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL ss329) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2016-09-02 |