| NPI | 1366969545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE 11243) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 7172) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2017-08-28 |