| NPI | 1386196111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK CSWS1281) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-23391) |
| 1041C0700X Social Worker, Clinical (Licence: ME LC25335) | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2026-08-12 |