| NPI | 1073746772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P003878) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC P003878) |
| 104100000X Social Worker (Licence: NC P003878) | |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2009-08-27 |