| NPI | 1114362100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW15241) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LMSW-12380) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2015-08-07 |