| NPI | 1639630213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK CSW-1261) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW15510) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09924552) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2019-03-27 |