| NPI | 1619979499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW 11802) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS LSCSW 2242) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2016-03-16 |