| NPI | 1578789236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C006238) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-12357) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2019-12-27 |