| NPI | 1659670180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NE 1506) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 4256) |
| 101YM0800X Counselor, Mental Health (Licence: NE 1601) | |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2022-03-14 |