| NPI | 1831240837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW 0611) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LISAC 1029) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2010-04-05 |