| NPI | 1508610247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: FL CBHCM.0106555-P) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PR 8321) |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2024-04-17 |