| NPI | 1083023725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC P010262) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 104100000X Social Worker | |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2016-04-06 |