| NPI | 1689626293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AZ LCSW-3693) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LCSW-3693) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2008-01-30 |