| NPI | 1871855528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW16220) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW004836) |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2020-06-12 |