| NPI | 1548277700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MS C0690) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MS C0690) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-08-14 |