| NPI | 1659036069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM SW-2024-0368) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09931245) |
| 1041C0700X Social Worker, Clinical (Licence: OR L15521) | |
| 1041C0700X Social Worker, Clinical (Licence: ME LC24022) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904017557) | |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2025-04-26 |