| NPI | 1467827139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L12977) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-18630) | |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2021-12-28 |