| NPI | 1265556336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253J00000X Foster Care Agency (Licence: AZ 368267) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-12447) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2018-08-22 |