| NPI | 1407369648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LMSW-18388) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S.1700195-TRNE) |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2020-10-02 |