| NPI | 1801147038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 80765) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AK 192890) |
| 1041C0700X Social Worker, Clinical (Licence: WY 1451) | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW61233547) | |
| 1041C0700X Social Worker, Clinical (Licence: AR 12022-C) | |
| 1041C0700X Social Worker, Clinical (Licence: UT 12784405-3501) | |
| 1041C0700X Social Worker, Clinical (Licence: ND 6344) | |
| 1041C0700X Social Worker, Clinical (Licence: OK 6272) | |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2023-03-25 |