| NPI | 1467647701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P013868) |
| Additional Taxonomies | 101Y00000X Counselor |
| 1041C0700X Social Worker, Clinical (Licence: NC C014200) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2021-08-19 |