| NPI | 1346723368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-17296) |
| 1041C0700X Social Worker, Clinical (Licence: AL 6165C) | |
| 1041C0700X Social Worker, Clinical (Licence: OR L8336) | |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2025-05-21 |