| NPI | 1750947446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 17370) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 12626) |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2020-08-21 |