| NPI | 1124758602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 28530) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW025578) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06544300) | |
| 1041C0700X Social Worker, Clinical (Licence: DC LC200004715) | |
| 1041C0700X Social Worker, Clinical (Licence: DE Q1-0012675) | |
| 101YM0800X Counselor, Mental Health (Licence: DE Q1-0012675) | |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2026-04-16 |