| NPI | 1730195629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 05426) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW8222) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2024-02-09 |