| NPI | 1831441914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW15778) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09923924) |
| 1041C0700X Social Worker, Clinical (Licence: CA 73234) | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2019-05-06 |