| NPI | 1679012173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT 30085) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-16502) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2022-07-21 |