| NPI | 1932494317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 118453) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL ISW 6675) |
| 104100000X Social Worker (Licence: TN LSW0000009053) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2015-06-08 |