| NPI | 1184717209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 591) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 189) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2013-03-07 |