| NPI | 1528518206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10831088-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW023522) |
| 1041C0700X Social Worker, Clinical (Licence: NC C015803) | |
| 1041C0700X Social Worker, Clinical (Licence: ID LCSW-42760) | |
| 1041C0700X Social Worker, Clinical (Licence: TX 107580) | |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2026-04-17 |