| NPI | 1548924533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 20707) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2025036763) |
| 1041C0700X Social Worker, Clinical (Licence: AR 27919-C) | |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2026-05-12 |