| NPI | 1750801932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-21747) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 95004) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2026-02-10 |