| NPI | 1063554210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 7834) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS22682LCSW) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |