| NPI | 1639244239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker (Licence: AZ LCSW-10822) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2011-04-01 |