| NPI | 1013172667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: AZ LMSW-19613) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW- 13463) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2021-07-14 |