| NPI | 1508056722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: VA 0904000285) |
| 1041C0700X Social Worker Clinical (Licence: FL 12478) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2023-06-13 |