| NPI | 1558691279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 21334) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 1219) |
| 1041C0700X Social Worker, Clinical (Licence: NE 9058) | |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2025-05-08 |