| NPI | 1093045726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-33005) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LMSW-29786) |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2019-08-13 |