| NPI | 1306131511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-17210) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LMSW-13186) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2018-08-21 |