| NPI | 1881909646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW10457) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW003284) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2012-03-07 |