| NPI | 1871140418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW17505) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL ISW-12133) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2021-01-06 |