| NPI | 1043754682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW13997) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149026857) |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2024-12-06 |