| NPI | 1821622523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW18211) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: SC 13206) |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2021-07-21 |