| NPI | 1538374228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AR 1168C) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR 1168-C) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2011-08-09 |