| NPI | 1174837660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW10093) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL ISW2620) |
| Enumeration Date | 2010-07-27 |
| Last Update Date | 2023-01-30 |