| NPI | 1235802166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-23542) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: AZ LMSW-16688) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2026-05-19 |