| NPI | 1275966384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 6531111-3501) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 6531111-3502) |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2022-12-13 |