| NPI | 1457512410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM x-07238) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NM m-06732) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2010-12-15 |