| NPI | 1356480487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NE 1339) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 3607) |
| 1041C0700X Social Worker Clinical (Licence: TX 105496) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2023-03-07 |