| NPI | 1497163356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AR 7213C) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR 7213-M) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2021-04-22 |