| NPI | 1215929450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 957) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 686) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2007-11-19 |