| NPI | 1255781902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-19807) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-155236) |
| 1041C0700X Social Worker, Clinical (Licence: GA CSW009914) | |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2026-08-19 |