| NPI | 1225048655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2674) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IA 06492) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2007-07-08 |