| NPI | 1265864425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00945355) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 5152) |
| Enumeration Date | 2013-07-30 |
| Last Update Date | 2018-09-11 |