| NPI | 1811103351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH25016) |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2025-02-07 |