| NPI | 1952731176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-13806) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 345611-3501) |
| Enumeration Date | 2013-11-25 |
| Last Update Date | 2013-11-25 |