| NPI | 1629518840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 19699) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AK 216687) |
| 1041C0700X Social Worker, Clinical (Licence: MA LICSW126715) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904014) | |
| 1041C0700X Social Worker, Clinical (Licence: DC LC50082718) | |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2024-09-10 |