| NPI | 1255662508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1275) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 1142) |
| 101YM0800X Counselor, Mental Health (Licence: NE 2826) | |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2024-02-12 |