| NPI | 1780147215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 15382) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 1041C0700X Social Worker, Clinical (Licence: FL SW15382) | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2025-07-29 |