| NPI | 1154538593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW14834) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 54198) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2024-05-06 |