| NPI | 1245941632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-21024) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LMSW-17909) |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2022-12-16 |