| NPI | 1568619138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: SC LISW-CP-9860) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 104100000X Social Worker (Licence: SC LMSW-9860) | |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2020-01-30 |