| NPI | 1285977959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-15350) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LMSW-13565) |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2015-04-06 |