| NPI | 1124271523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 1055) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 2498) |
| Enumeration Date | 2008-10-29 |
| Last Update Date | 2009-11-20 |