| NPI | 1164778874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW25987) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL CBHCMS.0100116) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2026-02-09 |