| NPI | 1578102604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904012976) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NC P013828) |
| 104100000X Social Worker (Licence: VA 0903002709) | |
| 1041C0700X Social Worker, Clinical (Licence: TX 112232) | |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2025-07-27 |