| NPI | 1356006423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW18593) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL SW18593) |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2021-11-03 |