| NPI | 1851510812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AZ LCSW-0194) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AZ SW01941) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2008-03-28 |