| NPI | 1053747766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW2663) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS29375) |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2013-09-26 |