| NPI | 1548708027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW17613) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL ISW8833) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2023-12-07 |