| NPI | 1861657827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW 9523) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA # 115341) |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2014-07-11 |