| NPI | 1336686450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW25167) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09932722) |
| 1041C0700X Social Worker, Clinical (Licence: NM SWB-2026-0029) | |
| 1041C0700X Social Worker, Clinical (Licence: MA LICSW1143442) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149031836) | |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2026-05-18 |