| NPI | 1306913660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-49604) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 889) |
| 1041C0700X Social Worker, Clinical (Licence: NE 590) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2021-10-04 |