| NPI | 1467977314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093691) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 15626) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06560600) | |
| 1041C0700X Social Worker, Clinical (Licence: TX 114988) | |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW009977) | |
| 1041C0700X Social Worker, Clinical (Licence: ME LC24455) | |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2026-03-05 |