| NPI | 1750303772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: UT 372115-3501) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: AZ LCSW-18561) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2022-01-25 |