| NPI | 1073820866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C007846) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC P005950) |
| 104100000X Social Worker (Licence: NC P005950) | |
| 1041C0700X Social Worker, Clinical (Licence: NC P005950) | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2016-03-08 |