| NPI | 1437201225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 24565) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041S0200X Social Worker School (Licence: MD 24565) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2019-08-22 |