| NPI | 1841571353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7915180-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WY LCSW-871) |
| 1041C0700X Social Worker, Clinical (Licence: VA 0904013199) | |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2023-07-16 |