| NPI | 1730431586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW 12173) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL ISW 6541) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2015-12-10 |