| NPI | 1164180048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P016345) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149031367) |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW009592) | |
| 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-22846) | |
| 1041C0700X Social Worker, Clinical (Licence: WY LCSW-1745) | |
| 1041C0700X Social Worker, Clinical (Licence: KS LSCSW06347) | |
| 1041C0700X Social Worker, Clinical (Licence: NC C016677) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904016357) | |
| 1041C0700X Social Worker, Clinical (Licence: IA 124508) | |
| 1041C0700X Social Worker, Clinical (Licence: SD License) | |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2026-04-22 |