| NPI | 1265930655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-20365) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 8446-C) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.1901465) | |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2023-08-22 |