| NPI | 1942341276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW3824) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904015286) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2024-05-14 |