| NPI | 1033879366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW22398) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN 9410) |
| 1041C0700X Social Worker, Clinical (Licence: ID LCSW-44686) | |
| 1041C0700X Social Worker, Clinical (Licence: OH I.2506563) | |
| 1041C0700X Social Worker, Clinical (Licence: NV 12715-C) | |
| Enumeration Date | 2021-12-28 |
| Last Update Date | 2026-07-23 |