| NPI | 1598017857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW11504) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL ISW6514) |
| Enumeration Date | 2012-10-11 |
| Last Update Date | 2023-02-06 |