| NPI | 1962256925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149028558) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34011307A) |
| 1041C0700X Social Worker, Clinical (Licence: WI 12030-123) | |
| 1041C0700X Social Worker, Clinical (Licence: ID 4461974) | |
| 1041C0700X Social Worker, Clinical (Licence: FL TPSW4390) | |
| 1041C0700X Social Worker, Clinical (Licence: DE Q5-0000182) | |
| 1041C0700X Social Worker, Clinical (Licence: VT 089.0135999TELE) | |
| 1041C0700X Social Worker, Clinical (Licence: SC TLS969CP) | |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2025-10-02 |