| NPI | 1063185437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 20915) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL ISW14147) |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2023-05-09 |