| NPI | 1104547421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 108269) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ND 6577) |
| 1041C0700X Social Worker, Clinical (Licence: MA 127932) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 119727) | |
| 1041C0700X Social Worker, Clinical (Licence: VT 089.0135350) | |
| Enumeration Date | 2022-09-06 |
| Last Update Date | 2025-10-24 |