| NPI | 1063217156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW24238) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 6281C) |
| Enumeration Date | 2025-02-13 |
| Last Update Date | 2025-09-03 |