| NPI | 1205024155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3251) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NE 1243) |
| 363A00000X Physician Assistant (Licence: NE 1664) | |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2015-05-26 |