| NPI | 1508889296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 6652) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WI 6652) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-10-03 |