| NPI | 1811062284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW60060718) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 3999) |
| 1041C0700X Social Worker, Clinical (Licence: NC C005206) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 24674) | |
| 1041C0700X Social Worker, Clinical (Licence: OR L12884) | |
| 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-20100) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2022-08-07 |