| NPI | 1083873806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NE 6467) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 7872) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2021-12-02 |