| NPI | 1205691276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW23903) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1141572) |
| 1041C0700X Social Worker, Clinical (Licence: OR L16606) | |
| 1041C0700X Social Worker, Clinical (Licence: CA CA134904) | |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2025-11-07 |