| NPI | 1497164347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW- 36181) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCSW-36181) |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2020-10-23 |