| NPI | 1679109524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: FL ISW12744) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL ISW12744) |
| Enumeration Date | 2020-03-22 |
| Last Update Date | 2020-03-22 |