| NPI | 1275608192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NC C005490) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C005490) |
| 101YM0800X Counselor, Mental Health (Licence: NC C005490) | |
| 101YP2500X Counselor, Professional (Licence: NC C005490) | |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2024-07-15 |