| NPI | 1356042543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW24050) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL ISW16790) |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2025-02-07 |