| NPI | 1386002236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional | |
| 103TC1900X Psychologist Counseling | |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2017-02-23 |