| NPI | 1134460918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-34224) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 9343) |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2015-01-16 |