| NPI | 1619212792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AZ LCSW-18300) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NC C008184) |
| Enumeration Date | 2012-11-30 |
| Last Update Date | 2023-05-09 |