| NPI | 1932821956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW17317) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW007974) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2022-09-15 |