| NPI | 1679798235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 9987) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW9987) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2024-12-30 |