| NPI | 1053051441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW20454) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL ISW14871) |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2024-03-30 |