| NPI | 1053878975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 323944-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2022013753) |
| 1041C0700X Social Worker, Clinical (Licence: NY 096467) | |
| 1041C0700X Social Worker, Clinical (Licence: WV TH00946205) | |
| Enumeration Date | 2019-02-27 |
| Last Update Date | 2023-12-07 |