| NPI | 1447557665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 1143) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA LW60188244) |
| 1041C0700X Social Worker, Clinical (Licence: AZ LCSW19350) | |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2023-03-27 |