| NPI | 1033287198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AL 2065C) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL 2065C) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2021-08-03 |