| NPI | 1093004764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904012083) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-17879) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2021-09-04 |