| NPI | 1700391067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-1465) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID MBTSWO-44324) |
| 1041C0700X Social Worker, Clinical (Licence: MT BBH-SWLC-LIC-50447) | |
| 1041C0700X Social Worker, Clinical (Licence: WA SC61282484) | |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2024-01-15 |