| NPI | 1669046538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC200001787) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 18961) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149030424) | |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904014798) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 137308) | |
| Enumeration Date | 2021-05-16 |
| Last Update Date | 2026-08-14 |