| NPI | 1922622042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW16639) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 13344228-3501) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929192) | |
| 1041C0700X Social Worker, Clinical (Licence: AZ 21854) | |
| 1041C0700X Social Worker, Clinical (Licence: NE 3594) | |
| 1041C0700X Social Worker, Clinical (Licence: MN 30850) | |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2024-04-25 |