| NPI | 1295274462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KS 5047) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: TX 107209) |
| 1041C0700X Social Worker Clinical (Licence: MO 2017000663) | |
| 1041C0700X Social Worker Clinical (Licence: OK 8065) | |
| Enumeration Date | 2017-02-21 |
| Last Update Date | 2023-12-18 |