| NPI | 1104555994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW22455) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 112522) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904020629) | |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2026-06-20 |