| NPI | 1699361923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 21498) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 105083) |
| 1041C0700X Social Worker, Clinical (Licence: TN 8106) | |
| 1041C0700X Social Worker, Clinical (Licence: HI LCSW-4970-0) | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW61045082) | |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2025-03-19 |