| NPI | 1558829234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61418510) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 14298209-3501) |
| 1041C0700X Social Worker, Clinical (Licence: NC C017890) | |
| 1041C0700X Social Worker, Clinical (Licence: SC 17200) | |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2026-08-07 |