| NPI | 1245381508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DE Q1-0000617) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0000617) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2012-01-19 |