| NPI | 1225278930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-14134) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LASAC-13102) |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2014-07-08 |