| NPI | 1841661485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-9908) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-32617) |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2015-10-15 |