| NPI | 1801564729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 138109) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 14280971-3501) |
| 1041C0700X Social Worker, Clinical (Licence: TX 119740) | |
| 1041C0700X Social Worker, Clinical (Licence: OR L18532) | |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2026-08-11 |