| NPI | 1235957044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 12282390-3501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-15843) |
| Enumeration Date | 2024-09-30 |
| Last Update Date | 2024-09-30 |