| NPI | 1124375563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 9719) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 6822) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2014-02-18 |