| NPI | 1902335839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW14501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 7576-C) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2021-09-07 |