| NPI | 1730771809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10830955-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID 8271692) |
| 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-23772) | |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2026-06-16 |