| NPI | 1710411467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW19794) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL isw11411) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2024-06-06 |