| NPI | 1891383675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LMSW-16902) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW22446) |
| Enumeration Date | 2021-01-06 |
| Last Update Date | 2025-01-02 |