| NPI | 1609196781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-17722) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 117264) |
| 1041C0700X Social Worker, Clinical (Licence: UT 7390038-3501) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2023-04-11 |