| NPI | 1154995140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-21800) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AZ LMSW-18770) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2023-10-03 |