| NPI | 1932365921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 16272) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW9037) |
| Enumeration Date | 2008-07-30 |
| Last Update Date | 2021-10-27 |