| NPI | 1770049116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW18058) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904012773) |
| 1041C0700X Social Worker, Clinical (Licence: DC LC200001605) | |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2024-11-04 |