| NPI | 1902981624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-12461) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 6962-123) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2010-08-11 |