| NPI | 1891359402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW19198) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA SW126527) |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2026-01-23 |