| NPI | 1053743443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L4134) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-17754) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2026-06-03 |