| NPI | 1114225653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 289637-3503) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2021-01-08 |