| NPI | 1487412797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW25723) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL SW25723) |
| 104100000X Social Worker (Licence: AZ LMSW-21964) | |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2025-11-20 |