| NPI | 1124751441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 11302959-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-23132) |
| 1041C0700X Social Worker, Clinical (Licence: ID 5471460) | |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2026-02-09 |