| NPI | 1740757400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: AZ LMSW-17249) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-21113) |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2023-02-02 |