| NPI | 1184192221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C012706) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW15534) |
| 1041S0200X Social Worker, School (Licence: FL SW15534) | |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2024-01-26 |