| NPI | 1255075123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW22943) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904017546) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2024-10-23 |