| NPI | 1467578351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM C-09356) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LCS13422) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2017-04-27 |