| NPI | 1962190454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW21664) |
| Additional Taxonomies | 104100000X Social Worker (Licence: GA MSW010188) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2025-01-27 |