| NPI | 1821492596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW15636) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL ISW 9093) |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2021-06-07 |