| NPI | 1437488822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C009850) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW11579) |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2026-01-31 |