| NPI | 1467697151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 70535) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R0405341) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2017-01-19 |