| NPI | 1104259837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 3892) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: DC 184) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2013-08-16 |