| NPI | 1073399671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL ISW23498) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: FL NCPS0100179) |
| 1041S0200X Social Worker, School (Licence: FL 1571845) | |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2026-08-17 |