| NPI | 1982369450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW18472) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1141252) |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2026-05-08 |