| NPI | 1588218127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 103673) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA CSW007217) |
| 1041C0700X Social Worker, Clinical (Licence: MA 122188) | |
| 1041C0700X Social Worker, Clinical (Licence: FL SW15828) | |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2021-06-17 |