| NPI | 1659676690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 8841) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NE 6671) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2011-01-24 |