| NPI | 1063895506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AZ 11062) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: AZ AL8954H) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2025-06-11 |