| NPI | 1104856715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 3280) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TN 3280) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2012-05-10 |