| NPI | 1871370957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: FL SW25660) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 6612C) |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2025-12-15 |