| NPI | 1376069963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-19500) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 9153-123) |
| 1041C0700X Social Worker, Clinical (Licence: WI 130673) | |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2022-02-12 |