| NPI | 1003421017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ LMSW17198) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: AZ LCSW-20779) |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2022-09-20 |