| NPI | 1558691279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: AZ 21334) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NE 9058) |
| 101YM0800X Counselor Mental Health (Licence: NE 1219) | |
| Enumeration Date | 2009-12-31 |
| Last Update Date | 2023-12-08 |