| NPI | 1396227468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: MO 2019039416) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 118537) |
| 1041C0700X Social Worker, Clinical (Licence: OK 22305) | |
| 1041C0700X Social Worker, Clinical (Licence: KS 07377) | |
| 1041C0700X Social Worker, Clinical (Licence: AR 28228) | |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2026-08-25 |