| NPI | 1447375019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW- 4111) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: AZ 1143816) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-1423) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2012-06-11 |