| NPI | 1831487420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 10640565-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW60448962) |
| 1041C0700X Social Worker, Clinical (Licence: ID LCSW-40573) | |
| 1041C0700X Social Worker, Clinical (Licence: MD 27620) | |
| 1041C0700X Social Worker, Clinical (Licence: MO 2021037248) | |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2026-08-15 |