| NPI | 1053597344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID 4472) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LPC3960) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2019-02-15 |