| NPI | 1013363639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SA60782831) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NJ 44SL06162600) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2018-03-17 |