| NPI | 1811372584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW18681) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-4248) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2026-09-08 |