| NPI | 1639771090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 32363) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 58.017083) |
| 1041C0700X Social Worker, Clinical (Licence: DE Q1-0012983) | |
| 104100000X Social Worker (Licence: PA SW141953) | |
| 133V00000X Dietitian, Registered (Licence: NY 010678) | |
| 104100000X Social Worker (Licence: NJ 44SL07091300) | |
| 104100000X Social Worker (Licence: NY 123109) | |
| 133V00000X Dietitian, Registered (Licence: 86006908) | |
| 104100000X Social Worker (Licence: AZ LMSW-22136) | |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2026-07-17 |