| NPI | 1245667237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: AR 697-C) |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2014-12-18 |