| NPI | 1336495282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 9789) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NE h13472181) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2012-10-10 |