| NPI | 1508844986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MS C5447) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MS C5447) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2008-07-28 |