| NPI | 1851723654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-17393) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ME MC14206) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2019-01-21 |