| NPI | 1891279287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34008256A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-21892) |
| 1041C0700X Social Worker, Clinical (Licence: TX 115494) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 1493020534) | |
| 1041C0700X Social Worker, Clinical (Licence: NH 3904) | |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2025-07-03 |