| NPI | 1043687999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 1041S0200X Social Worker, School | |
| 106H00000X Marriage & Family Therapist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2015-08-26 |