| NPI | 1508082074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 8166) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 8166) |
| 101YP1600X Counselor, Pastoral | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2011-06-21 |