| NPI | 1780921031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 6727) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM SWB-2025-0430) |
| 1041C0700X Social Worker, Clinical (Licence: FL TPSW5583) | |
| 1041C0700X Social Worker, Clinical (Licence: NC C009347) | |
| 1041C0700X Social Worker, Clinical (Licence: ID 7071070) | |
| 1041C0700X Social Worker, Clinical (Licence: VT 089.0136581TELE) | |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2025-10-08 |