| NPI | 1396617924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 103867) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID 4971292) |
| 1041C0700X Social Worker, Clinical (Licence: FL TPSW6449) | |
| 1041C0700X Social Worker, Clinical (Licence: MA LICSW1143431) | |
| 1041C0700X Social Worker, Clinical (Licence: DE Q5-0000329) | |
| 1041C0700X Social Worker, Clinical (Licence: SC TLS1787CP) | |
| 1041C0700X Social Worker, Clinical (Licence: PA CW027303) | |
| 1041C0700X Social Worker, Clinical (Licence: VT 089.0136927TELE) | |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09932913) | |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06608700) | |
| Enumeration Date | 2025-09-23 |
| Last Update Date | 2026-08-06 |