| NPI | 1003030107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ 13512) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ 13512) |
| 104100000X Social Worker (Licence: KS 6128) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2022-07-21 |