| NPI | 1598906778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 117408) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 19311) |
| Enumeration Date | 2009-03-17 |
| Last Update Date | 2024-08-17 |