| NPI | 1104296425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL TPSW1865) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PR 11818) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2024-11-27 |