| NPI | 1265746804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW17821) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC CO11438) |
| 1041C0700X Social Worker, Clinical (Licence: SC 14254) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904010885) | |
| 1041C0700X Social Worker, Clinical (Licence: OH I.1201554.SUPV) | |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2023-09-26 |