| NPI | 1457387615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 3949) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 3949) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2021-11-20 |