| NPI | 1578576534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OR L8340) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: ID LCSW-3197) | |
| 104100000X Social Worker (Licence: WA LW60169256) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2023-12-28 |