| NPI | 1629679048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCSW-44276) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AZ LMSW-18733) |
| 104100000X Social Worker (Licence: ID LMSW-40331) | |
| 1041C0700X Social Worker, Clinical (Licence: UT 8722060-3502) | |
| 1041C0700X Social Worker, Clinical (Licence: UT 8722060-3502CSW) | |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2023-10-18 |