| NPI | 1417606161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 103889) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW61484387) |
| 1041C0700X Social Worker, Clinical (Licence: MA LICSW1142840) | |
| 1041C0700X Social Worker, Clinical (Licence: NV 11220-C) | |
| 1041C0700X Social Worker, Clinical (Licence: NM SWB-2023-1075) | |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2026-01-09 |