| NPI | 1104184738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-30107) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 101YM0800X Counselor, Mental Health (Licence: ID 30107) | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2021-07-01 |