| NPI | 1609859495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 175-125) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 175-125) |
| 106H00000X Marriage & Family Therapist (Licence: WI 169124) | |
| 101YM0800X Counselor, Mental Health (Licence: WI 175123) | |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2024-02-27 |