| NPI | 1508500588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-22774) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AZ LMSW-19763) |
| Enumeration Date | 2022-04-25 |
| Last Update Date | 2025-06-11 |