| NPI | 1568017986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 9732-123) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-22872) |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2025-04-18 |