| NPI | 1750060703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW22364) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2023-07-17 |
| Last Update Date | 2025-01-21 |