| NPI | 1780780346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-2856) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 22914) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |