| NPI | 1023267382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 17421) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 10900) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2023-03-15 |