| NPI | 1184218414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW18057) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 18057) |
| 1041C0700X Social Worker, Clinical (Licence: UT 14282514-3501) | |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2026-05-31 |