| NPI | 1235121385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C009466) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 1968 LMHP) |
| 1041C0700X Social Worker Clinical (Licence: NE 929 CMSW) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2016-11-28 |