| NPI | 1396178968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 82847) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI 04256) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW24585) | |
| 1041C0700X Social Worker, Clinical (Licence: MA ISW04256) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 904018416) | |
| Enumeration Date | 2013-08-18 |
| Last Update Date | 2025-05-29 |