| NPI | 1285997833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 7222) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904010807) |
| 1041C0700X Social Worker, Clinical (Licence: CT 15833) | |
| 1041C0700X Social Worker, Clinical (Licence: MN 32897) | |
| 1041C0700X Social Worker, Clinical (Licence: DC LC200004288) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2025-10-16 |