| NPI | 1982269155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 11338410-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW15210) |
| 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-22060) | |
| 1041C0700X Social Worker, Clinical (Licence: MA LICSW126861) | |
| 1041C0700X Social Worker, Clinical (Licence: WA LW61224850) | |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2024-06-05 |