| NPI | 1164575486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW0754) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT0182) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2023-11-30 |