| NPI | 1982698098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW 0107I) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-0085) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2007-07-08 |