| NPI | 1285948661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 9666) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW9666) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2025-06-28 |