| NPI | 1205575156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-21721) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AZ LMSW-17307) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2023-09-11 |